The role of Periostin as a biomarker of anterior cruciate ligament injury and potential therapeutic target to alleviate post-traumatic cartilage degeneration

Periostin, a matricellular protein, has emerged as a potential biomarker for anterior cruciate ligament (ACL) injury and has been associated with cartilage degeneration and the development of post-traumatic osteoarthritis (PTOA). This review aims to comprehensively examine and synthesize the existing literature concerning the role of Periostin in the aftermath of ACL injury, particularly its involvement in subsequent cartilage degradation processes within the knee joint. Conducting a scoping review, we systematically searched Medline, Scopus, and Embase, focusing on human and animal studies investigating Periostin in the context of ACL injury or PTOA. Analysis of Periostin expression in human synovial fluid and ACL tissue reveals distinctive temporal profiles, with peak levels observed at a minimum of 1-month post-ACL injury. In vitro data suggests that injured ACL tissue promotes Periostin expression in human chondrocytes. Animal studies demonstrate that recombinant Periostin application leads to increased cartilage degeneration, potentially mediated by enhanced Wnt signaling and MMP-13 expression. Conversely, Periostin knockdown studies indicate a mitigating effect on cartilage degradation. Periostin exhibits robust associations with biomarkers of cartilage degeneration in humans and progression of osteoarthritis in animals. However, the precise impact of Periostin in the context of ACL injury and its potential causal relationship with the onset of PTOA remain uncertain.